€40m for home care services; €20m will be allocated to ensure that the 10.4 million home help hours, 15,450 home care packages, 130 intensive home care packages and 313 transitional care beds provided in 2015 are maintained; €10m will ensure that the rate of service allocation can be maintained during the summer months; and €10m has been ring fenced for home care as part of the new winter initiative. As a result, we are not only maintaining home care and transitional care services at 2015 levels, but increasing them
€31m for people with disabilities as outlined by Minister McGrath, including funding to cover costs incurred from compliance with national residential standards, services provided to meet the changing needs of people with disabilities, and the provision of emergency residential places. Of this additional funding, €3m is ear-marked for new initiatives, including an additional provision for services to meet the need of school leavers with disabilities and the anticipated cost of a number of emergency residential placements arising this year.
€20m for Mental Health; restored and ring-fenced in the mental health budget. Minister McEntee and my Department will work with the HSE to ensure that our mental health services get the maximum benefit from this funding
€40m for a new winter initiative (up from €33m last year) to help address overcrowding in Emergency Departments. As an integral part of this initiative, I will increase resources for home care services (as above).
Cathaoirleach
I welcome this opportunity to address the House today on the Revised Estimates for 2016 for my Department (Vote 38).
Today’s Revised Estimates come in the context of the Government’s determination to put the fruits of economic success to work for the people by improving the services that really matter and make a difference to people’s lives.
I am privileged to have become Minister for Health at a time when we are in a period of reinvestment in the health services, which gives me the opportunity to address some immediate issues facing patients as well as meeting Programme for Government commitments I want to deliver in my first 100 days. This includes a Winter Initiative to manage overcrowding in Emergency Departments, an integral part of which is increased resources for home care services.
Of course, it is also of particular importance that this Revised Estimate places the health service on a sustainable financial footing. I welcome the statement from the Director General of the HSE that this additional funding has stabilised the finances for 2016 and allows a realistic target to be achieved, along with the emphasis he placed on the need for effective financial management.
Additional funding of €300m was provided in Budget 2016 and this, along with the Supplementary Estimate of €600m remaining in the health sector base moving into 2016, resulted in an increase of €900m over the 2015 budget, albeit that some of this had to address once off measures from the previous year.
Whilst the funding secured in the Budget was welcome, it was becoming increasingly clear that the HSE was facing financial challenges in 2016 – indeed, the National Service Plan as approved by my colleague Minister Varadkar, acknowledged the financial challenge facing the sector in 2016. The late approval of the 2016 Estimates has allowed the Government an opportunity to reconsider the Health Estimate in light of the emerging financial pressures.
I am very pleased to now announce that the Government is asking the Oireachtas to allocate a further €500m Exchequer funding for the health sector for 2016. This brings the gross current budget for the Health Sector for 2016 to €13.695 billion. This is equivalent to an increase of €1.4 billion compared to the original 2015 allocation of €12.295 billion, and €736m more than the final revised allocation for 2015. In percentage terms, this represents a 6% increase on the final revised budget for 2015 and indeed an 11% increase on the original voted budget for 2015.
This very welcome additional funding will stabilise the health sector financially, and allow the HSE to set realistic and achievable targets for service areas, while still requiring the HSE and service providers to demonstrate effective management control. It is an indication of the Government's commitment to reinvestment in our health services.
While I am confident that we are in a much more stable financial position than we have been for some time, 2016 and beyond contain real challenges. We have an increased and aging population, an increase in chronic conditions and new and expensive medicines and treatments. Our progress in diagnosis and screening for cancers and chronic diseases means more people require treatments. Health services all around the world are struggling with the issue of rising costs and Ireland is no exception. We must recognise the additional resource demands that come as a result of these new pressures.
Acknowledging these pressures, I am particularly pleased that the Dáil recently passed a motion to set up the new Committee on the Future of Healthcareto develop a single long term vision for healthcare and the direction of health policy in Ireland.
I firmly believe that the health service will benefit greatly from a single unifying vision that we can all get behind, and that can help to drive reform and development of the system over the next 10-years. In particular, it is important that we work towards achieving universal health care and the motion notes the importance of achieving a single tier health service where access to services is based. The Committee is due to provide a report to the Oireachtas within 6 months of its initial meeting. As Minister, I will provide full support to assist the committee as necessary.
I am grateful to my colleagues Ministers Noonan and Donohoe for their support and understanding in dealing with the challenges faced by the health sector.
Services to be delivered in 2016
The level of health services to be provided within the available funding is as set out in the HSE’s 2016 National Service Plan along with some Programme for Government commitments which I will outline later.
The service issues which will be addressed under the Revised Estimate, as outlined in the Service plan include funding to reduce Delayed Discharges and Emergency Department overcrowding, through providing additional funding for community beds and long term residential care. It also provides for continuing the investment to improve the standard of care in residential services for persons with a disability, through providing enhanced staffing levels, and improving the quality and standard of their surroundings. In the Primary care arena, the full year effect of the under 6’s and over 70’s free GP care is provided for, along with the extension, in the latter part of 2016, of GP care without fees to all children under 12. The further roll-out of BreastCheck, enhanced provision of Speech and Language therapy, developments to our maternity services in line with the Maternity Strategy and further additional funding for mental health were also provided for in the Health Estimate.
Acute Services
In both the budget and this Revised Estimate, additional funding required to maintain existing levels of service in the acute sector is provided. Funding is also provided for ongoing strategic developments in areas such as paediatric scoliosis, stroke telemedicine, the living donor programme and organ donor services, acute coronary care, bilateral cochlear implants and cancer services.
Earlier this year the Government launched the country’s first National Maternity Strategy which represents a significant milestone in terms of the development of national maternity policy. Additional funding has been provided for maternity service developments in 2016, all of which will be allocated in line with the Strategy.
The Programme for Government emphasises the need for sustained commitment to improving waiting times for patients, with a particular focus on those patients waiting longest. It commits to €15m funding to the NTPF for an initiative targeted at those waiting longest from a continuing investment of €50m per year to reduce waiting lists. The Department is currently engaging with the NTPF and the HSE in planning a dedicated 2016 waiting list initiative focused on endoscopy. The NTPF clearly has a role to play and next week I will be meeting with them to discuss further waiting list initiatives.
Services for Older People
Delayed discharges and waiting lists for acute services can arise when sufficient supports are not available for our older citizens in the community. Our population is ageing rapidly, with advances in healthcare leading to a dramatic rise in our older population. There is now a stronger emphasis on home care and other community services which provide a greater range of options to avoid admission to acute hospitals, support early discharges, and, where appropriate, to rehabilitate and re-able patients after periods of particular difficulty.
The HSE provides a range of community-based services aimed at ensuring older people receive safe, timely and appropriate care and treatment at the lowest level of complexity, and as close to home as possible. However, demand for these services is rising as more people are supported in their own homes rather than in hospitals or nursing homes and I am delighted that the Government has been able to respond to this demand by providing an extra €40m for home care in 2016.
For the future, the Programme for a Partnership Government commits to increasing funding for home care packages and home help year on year. Of the additional €40m, €20m will be allocated to ensure that the 10.4 million home help hours, 15,450 home care packages, 130 intensive home care packages and 313 transitional care beds provided in 2015 are maintained; €10m will ensure that the rate of service allocation can be maintained during the summer months; and €10m has been ring fenced for home care as part of the new winter initiative.
There will, however, always be a cohort of older people who require a quality long-term residential care option. This must continue to be available to anyone who needs it.
Service for People with Disabilities
The Government, together with the statutory and non-statutory agencies who provide services to people with disabilities, have been working towards empowering people with disabilities to live independent lives, provide them with greater independence in accessing the services they choose, and enhancing their ability to tailor the supports they require to meet their needs and plan their lives. This year, funding of €1.59 billion in total is being provided for health and personal social services for wide and complex range of services and supports for people with disabilities, including the additional €31m which was secured for Disability Services, as was outlined by Minister McGrath last week. The additional funding will cover costs incurred from compliance with national residential standards, services provided to meet the changing needs of people with disabilities, and the provision of emergency residential places. Of this additional funding, €3m is ear-marked for new initiatives, including an additional provision for services to meet the need of school leavers with disabilities and the anticipated cost of a number of emergency residential placements arising this year.
There is an onus on us all to use this substantial resource more effectively and efficiently. And most importantly, we must ensure that we are achieving real and significant improvements in the lives of people with disabilities.
These improvements are being driven through Transforming Lives, which is the programme to implement the recommendations of the Value for Money and Policy Review of Disability Services in Ireland.
Primary Care
Enhancing primary care, and integration of care between primary and secondary are priorities for the new Government. Significant progress has already been made. GP care without fees has been successfully introduced for children under the age of 6 years and all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees, without having to undergo a means test. The under 6s service includes age-based preventive checks focused on health and wellbeing, and a cycle of care for children with asthma. Other service developments include: the introduction of a Diabetes Cycle of Care for adult patients with Type 2 Diabetes; an enhanced support framework for rural GPs; and a revised list of special items of service under the contract to encourage the provision of more services in the primary care setting.
There will be further investment in primary care, an essential element of which must be a comprehensive new GP contract, including an extension of GP care without fees for all children aged 11 years and under, including the asthma cycle of care. Other measures proposed are expanded GP access to diagnostic services, and allowing more GPs around the country to offer minor surgery procedures.
Time Related Savings and Mental Health
There are two areas in particular I would, however, like to refer to in the context of these Revised Estimates, and they are home care services and Mental Health.
Members will be aware that in the context of the approval of the National Service Plan, it was agreed that €20m in time-related savings would be utilised to support services. I am pleased to say that as a result of the increased provision for health, we can provide the required funding for home care without relying on these time-related savings, and can therefore restore the full ring-fenced mental health budget. Minister McEntee and my Department will work with the HSE to ensure that our mental health services get the maximum benefit from this funding including, where appropriate, its use to support the development and refurbishment of the necessary facilities to house our new staff and provide more therapeutic surroundings for our service users.
Winter Initiative
In addition to the services set out in the National Service Plan, I’m also pleased to announce that there is also scope for us to provide for the implementation of Programme for Government commitments for the first 100 days. In particular, this additional funding allows us to provide €40m in funding for a winter initiative to help address overcrowding in Emergency Departments. This Initiative is currently in the early planning stages by both the Department and HSE. I have met with the ED Taskforce and asked for their input and there will be a specific ED Taskforce meeting on this initiative. It will seek to support actions which improve patient flow through acute hospitals, as well as enhancing primary care and social care services. As an integral part of this initiative, I will increase resources for home care services. As a result, we are not only maintaining home care and transitional care services at 2015 levels, but increasing them. The Programme for Government acknowledges the need to improve our services to our older citizens – the provision of additional home care services and transitional care will assist more older people to leave our acute hospitals when they are clinically ready to do so and this will allow patients awaiting admission in our Emergency Departments to be admitted. This initiative will also help more older people to remain independent at home, and continue to have active lives in their communities for as long as possible.
HSE’s Accountability Framework
Both my Department and the HSE recognise that the need for ongoing strengthened accountability and good governance within the HSE and voluntary bodies remains of critical importance in 2016. The HSE has reviewed its Accountability Framework after its first year of operation in 2015 and is involved in the ongoing implementation of the recommendations of that review. This is focused on strengthening the operation, effectiveness and application of the Accountability Framework throughout the organisation to date, and will identify further changes in order to improve the process.
The allocation to address the budget overrun in the HSE will be underpinned by improved governance and accountability. My officials and the HSE will be working on developing new and strengthened measures on this over the next fortnight. Health service management will be accountable for performing within the budget set by these additional resources. It is in the acute hospital sector that Government sees the greatest need for improved accountability and control. Because of this, the Programme for Government commits to establishing a Performance Management Unit which will work with individual hospitals where there are difficulties in order to achieve improvement. Establishment of this Unit will contribute to a stronger focus on operational control and accountability within acute hospitals. There should be support and recognition for managers who rise to the challenge of leading performance improvement within the funding available. I also see, as part of this, an enhanced role for the Oireachtas and Oireachtas Committees.
Quality
While taking about the need for improved performance, it is important to acknowledge progress that is being made and the work people are putting into delivering improvements. The Department of Health, is tomorrow (16th June) publishing the second annual report of the National Healthcare Quality Reporting system (NHQRS). This report presents health information related to immunisation uptake, cancer screening and survival, management of chronic diseases including asthma, chronic obstructive pulmonary disease, diabetes, stroke and heart failure. Information is also included on healthcare associated infection rates and antibiotic usage.
The report makes clear that many areas of our health services are performing well. Immunisation rates have improved and cancer screening rates continue to improve. A continuing downward trend for hospitalisation for heart failure and for diabetes can be observed. It also shows that survival rates for breast and colorectal cancer are improving. A further positive is the continuing downward trend of the last decade in deaths following admission to hospital with a heart attack or a stroke.
There are areas identified where further room for improvement exists. In particular, considerable variation can be seen between counties in rates of hospitalisation for common chronic diseases such as chronic obstructive pulmonary disease, asthma, diabetes and heart failure.
Presenting information this way is an important step in understanding the performance, quality and safety of our health services. It provides robust valid information for informing the estimates process for 2017.
Health Care Reform
Government is committed to the development of a modern, patient-centred health service.
There is, undoubtedly, a strong case for increased funding on health in the years ahead; however it is also important to acknowledge that, with growing demand, increasing health funding without building a more effective health and social care service will not, in itself, resolve the difficulties our services face. Our experience during the boom ‘Celtic Tiger’ years, when considerably increased funding was spent on health without always a satisfactory return, is a stark testament to that.
Providing more resources without changing what we do and how we do it simply does not work. The 2016 Service Plan acknowledges the necessity to continue the programme of health service reform, whilst at the same time, continuing to deliver the vast range of day-to-day services, many of which are complex and demand-led. We must work collectively to improve safety, quality and the patient experience for those who depend on our services. It is vital that qualitative aspects, such as the personal care and attention that patients receive, are the subject of focused efforts so that people's experience of the health service is safe, caring and pleasant.
Central to progress this year is the further development of the new Community Healthcare Organisations which will improve the way in which primary care in the community is delivered. Likewise, the reorganisation of public hospitals into Hospital Groups is designed to deliver improved outcomes for patients. CHOs and Hospital Groups will work together to provide care for patients in their area integrating acute interventions with community and primary care, and the CEOs and Chief Officers will be fully accountable for service delivery. The establishment of CHOs represents an important step in improving how care in the community is delivered. These new structures will provide the public with better care close to home and give people confidence that they can avail of a comprehensive range of services in their communities. The objective is to maximise the amount of care delivered locally while ensuring that specialist and complex care is safely provided in larger hospitals.
The new Government remains committed to the further development of activity-based funding. Under this model, hospitals are paid for the work they do in terms of case loads and quality outcomes subject to an overall cap in terms of the available funding. This funding model will drive efficiency and increase transparency in the provision of high-quality hospital services. The HSE intends to further implement this new funding model in 2016.
One of the most significant areas of reform is the area of the national clinical programmes, which have greatly improved services in specialised areas like stroke and cardiology. These national programmes are organised into five integrated care programmes, which must be central to operational delivery and reform. While reform is never an end in itself, it is a valuable tool that can help us do more and better with the additional resources we now have. Better structures empower people to deliver better care.
Conclusion
There are enormous demands and cost pressures on our health service. Health care demand continues to rise due to our growing and ageing population, the increasing incidence of chronic conditions and advances in medical technologies and treatments.
We have secured a substantial increase in funding for the health services for 2016 but I do not underestimate the challenges involved in the delivery of a safe efficient health service for Irish patients. Health systems all around the world are struggling with the issue of rising costs – Ireland is in no way unique in this, and maintaining the pace of reform is fundamental. We must maintain our focus on improving the way services are organised and delivered and reducing costs in order to maximise service provision.
In order for Government to have the confidence to prioritise additional investment in our health services in 2017 and beyond, it is essential that the managers within the service demonstrate good practice by delivering the maximum amount of safe services within the limits of resources that have been made available by government each year.
That said, the Government’s core objective is to use the strengthening economy to make life better for the Irish people and I believe the Revised Estimate provides me as Minister for Health with an opportunity to make realistic and achievable progress on improving patient care. I am also determined to advance significant investment projects like the National Children’s Hospital and progress key public health initiatives like the National Obesity Strategy and the National Cancer Strategy.
Before concluding I would like to take this opportunity to pay tribute to health care staff who have taken us through some very difficult years. Whilst there have undoubtedly been issues, there are also many positive elements which too often get overlooked. It is due to their hard work, commitment and dedication that the Irish health service survived the most challenging period in its history. We still face challenges, but there is every reason for optimism and believing that things are now more manageable, and we have a chance to embark together on a journey towards a better place for patients and staff.
To conclude, I thank the Members for their attention and I commend the Estimates for the Health Vote to the House. I will of course be glad to supply any further information or clarification that Members may request.